long-term care use and supply in europe: projections for germany ...

LONG-TERM CARE USE AND SUPPLY IN EUROPE | 27
Conclusion
Using SHARE data, factors affecting current use of formal and informal care by persons aged 65 and
over, living at home, have been examined for Germany, the Netherlands and Spain, countries
representative of different LTC systems. The analysis has focused on help with personal care tasks or
activities of daily living. Help with household tasks has not been included. Probabilities of using formal
personal care, either alone or in combination with informal personal care, have been found to be much
higher in the Netherlands than in Spain and Germany, while probabilities of using informal personal
care, either alone or in combination with formal personal care, are much higher in the latter countries.
Multinomial regression models have further showed that age, household composition and ADL or IADL
limitations are important determinants of personal care utilisation in all three countries. The same
factors have consistently been found to be strongly associated with home care use in previous studies.
However, model results have also shown that age gradients of care use differ considerably between the
three countries, as does the impact of potential availability of informal care. While in Germany, higher
age significantly increases the chances of combining formal and informal care, with no or little effect on
using formal or informal care only, in the Netherlands, higher age predominantly increases use of formal
care, but has less influence on using informal care, either alone or in combination with formal care. In
Spain, age is significantly associated with using informal care only, but not with the other categories of
care use. Looking at household composition, living alone increases the likelihood of using formal care
only, but has no impact on use of informal care in the Netherlands. In contrast, in Spain it decreases the
likelihood of using informal care, but has no impact on use of formal care only. In Germany, older
persons living alone have a lower probability of using informal care only and a higher probability of
using formal care only. Finally, some evidence has been found for country differences in the association
of care use and need factors.
Given the generally strong association of personal care use with ADL limitations and the fact that
numbers of ADL dependent persons are projected to increase considerably in future years, one can
expect considerable increases in future numbers of informal and formal care users in all three countries.
However, the present analysis suggests that the impact of demographic ageing and other societal trends,
like changing living arrangements of older people, might well be different, as the association of care use
with age and household composition varies across countries. Using results of the analysis of
determinants of formal and informal care use, projections have been made of the numbers of older
persons using formal and informal care between 2010 and 2060. The projection model and projection
results are discussed in Chapter 4.
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